7 ways to help kids cope with coronavirus (COVID-19) anxiety

If the ongoing spread of coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around, and we don’t know how long it will last.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including schoolwork, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “Coronavirus is a new type of germ that can make some people very sick, and so it is important for us to wear masks around people other than our family, keep 6 feet away from people outside our family, wash our hands more, avoid touching our face, and spend time outside rather than in buildings to keep ourselves and others healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus and will let us know when it is safe to return to certain activities. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by wearing a mask, staying 6 feet away from others, practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide For example, if you are expecting to be staying at home for a while, ask the child what they might want to snack on or what activities they might enjoy. Be creative with helping your child choose activities that appeal to their passions or curiosities.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tell them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • Educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.

This article was updated on August 18, 2020.

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Understanding the role of cultural stigma on seeking mental health services

By Dr. Sheila Modir, pediatric psychologist; Baleska Alfaro, licensed marriage and family therapist; and Dr. Ava Casados and Dr. Sarah Ruiz, post-doctoral fellows at CHOC Children’s

For some people, making an appointment with a mental health provider may be a personal and independent decision. For others, the decision to seek therapy services may be influenced by their culture or community, as each culture has its own understanding, interpretation and beliefs around mental health symptoms.

Our own culture also teaches us ways to cope with distress and whom to rely on for support during difficult times. This may impact whether a person seeks mental health services and treatment, or their decision not to seek care at all.

In many cultures, negative stigma about mental health symptoms or therapy services is a major obstacle to getting professional help. Research shows that people in racial and ethnic minority groups in the U.S. are less likely than White people to seek outpatient therapy services. Many ethnic minority groups are more comfortable going to their primary care physicians or family members for assistance with mental health symptoms as opposed to speaking with a mental health provider. We all want to be accepted by our communities, and sometimes fear of shame or embarrassment prevents people from seeking mental health treatment.

For instance, Black families may be understandably reluctant to seek mental health therapy due to the longstanding history of discrimination, racism and mistreatment the Black community has experienced at the hands of providers in the U.S. Instead, they tend to take an active approach in handling adversities independently and directly. They also tend to rely more on spiritual resources for emotional support. While these beliefs and approaches are valid, overly negative views of therapy can keep children who do need a higher level of care from getting that help.

Studies show that Latinx (a gender neutral reference to a person of Latin American cultural or ethnic identity in the U.S.) families are also less likely to trust mental health providers compared to White families and are more likely to rely on social support from extended family and other community members. When Latinx individuals do tell others about their experiences with stress or emotional difficulties, they often focus on physical symptoms such as trouble sleeping or loss of appetite and are less likely to discuss the thoughts or feelings that are bothering them.

For Asian American and Middle Eastern American communities, cultural beliefs that seeking mental health treatment will bring shame and dishonor to the family leads some people to internalize their symptoms instead of seeking therapy. Many Asian American children have described feeling pressured to appear perfect and successful, and therefore keep their symptoms secret. For Middle Eastern American adolescents, research has found that they tend to seek support from other family and religious community members.

While these beliefs and approaches are valid, overly negative views of therapy can keep children who do need a higher level of care from getting that help.

These examples are broad, but they illustrate just a few of the reasons why ethnic minority children are much less likely to receive therapy when they need it. Ultimately, it is the responsibility of the mental and medical health system to make services more accessible to under-served families, and to spark change to counteract myths about the stigma of mental health symptoms and mental health treatment. Parents can also play an important role in examining their family’s own cultural beliefs about treatment and identifying ways to advocate for their children to get expert help whenever they need it.

How our community can end mental health stigma

So, how do we, as parents, healthcare professionals and the community begin to work on eliminating the stigma surrounding mental health disorders and accessing mental health services? After all, one in five children experiences a mental health disorder.

Here are some tips that can help our children and families feel more comfortable with identifying, discussing, managing and accessing services for mental health.

  1. Seek reliable information — A first step that we can take to end mental health stigma is to seek out reliable and accurate information about mental health disorders, treatment options and resources in our community. Trusted sources can include, but are not limited to:

When speaking to children about mental health, use resources that are age-appropriate and engaging. A young child may find books helpful, while an older child may prefer to get information online. Look over resources with your child to help them find reputable sources of information and avoid popular social media platforms as your only source of information. Not sure how to start? Here are a few resources for kids:

  1. Use appropriate language — The resources listed above can help you understand how to talk to your children about mental health issues, as well as how to dispel mental health myths they might have heard about conditions and treatment. Using correct language can reduce any shame or guilt you or your family and friends may have about mental health and can create a space that makes it easier for children and teens to speak openly about their own struggles and seek help.

 

  1. Celebrities normalizing mental health conditions — Because so many people live with and manage symptoms related to a mental health condition, it isn’t hard to find a celebrity or well-known public figure your child admires who has a mental health condition. We can use celebrity or public figure examples to help normalize mental health conditions and access to mental health treatment. Our children will be more open to discussing their mental health condition and to trying out mental health services if they know that their favorite singer, actor or athlete also lives with a mental health condition.

 

  1. Learn to explain your child’s mental health condition to your support system and community — Once we have accurate information about our child’s mental health condition and treatment plan, it could help to share this information. If we share information about mental health with our families, schools or places of worship, as well as other members of our support system, they can each better understand the child’s mental health and how they manage symptoms. Sharing information can also help increase empathy and support for the child’s well-being.

 

  1. Seek support in your community — Children and teens with mental health conditions may not know anyone else with a similar diagnosis, which can impact their self-esteem. For teens especially, finding support from an online community may be a helpful way to openly speak about their mental health condition. Parents may also benefit from knowing other parents with children who have mental health conditions, as this can allow families to find a sense of community or support. Your local National Alliance on Mental Illness chapter offers peer support groups for parents and individuals with mental health conditions.

 

  1. Advocacy — Engaging in advocacy is another way that parents and community members can help break down mental health stigma. Organizations like National Alliance on Mental Illness engage in advocacy and policy change using individual’s stories. Advocacy can help raise awareness about important mental health issues and help dispel myths and break down stigma. It could also have positive impacts for those who are engaging in advocacy, helping to develop a sense of solidarity and common purpose.
Learn more about mental health services at CHOC

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Monitoring your child’s news and social media intake during COVID-19

By Dr. Chris Min, pediatric psychologist at CHOC Children’s and Luiza Mali, predoctoral intern at CHOC Children’s

Throughout the COVID-19 pandemic, many of us have experienced a thirst for answers and information — especially to help guide our behavior and try to put our worries at ease. Due to social isolation, many of us have looked online and to social media to fulfill those needs. From receiving breaking news on our smartphones regarding updated guidelines to scrolling through our social media feeds to learn about  numbers of infections, we are constantly bombarded with information. As parents, many of us have wondered whether our children’s increased exposure to repetitive and gloomy news is harmful, and whether the information our children consume may come at a cost.

What happens to our minds when we are overexposed to the news

Research shows that continual media coverage of community or health crises — such as COVID-19 — overexposes us to negative information, and this information becomes overrepresented in our minds. This overexposure increases the perception of threat and makes worry more difficult to control.

These psychological risks are particularly true for children, who tend to be more emotionally reactive or have difficulty dealing with uncertainty. For younger children, intaking a huge amount of information may be confusing, overwhelming and raise more questions than answers. For older children and adolescents, particularly those who are worriers, the likelihood of something bad happening may seem like a certainty to them, and that can lead to catastrophic thoughts about the present and future.

Should I isolate my child from the news during COVID-19?

Isolating your child from any information regarding COVID-19 can create a variety of problems. Many times, parents assume that their children are either too young or oblivious to changes in their environment to wonder about why their daily routine looks different. However, children tend to notice these changes, although they may not verbalize their concerns to their parents.

With many changes to their routine and lifestyle — distance learning and social distancing to name a few — that profoundly affect a child’s day-to-day schedule, even young children may notice and wonder why these changes are happening. If parents shield their children from any and all information about why they aren’t going to school or can’t go to their friend’s house, children can feel confused and disappointed.

For older children and teenagers who have unsupervised access to social media and television, parents leave what and how much information is given to their children up to chance. This age group may catch a glimpse of what’s on the news or what friends share on social media, leading to more potential confusion — especially if parents hold back from giving their own accurate take on things.

For these reasons, it is important to ensure that your family is consuming media responsibly and is striking a good balance between absorbing relevant information and protecting your mental health.

Here are some developmentally appropriate ideas to ensure that your family is interacting with media in a careful and helpful way during COVID-19:

Younger children and media

  • Filter the kind of information young children are exposed to.
  • For toddlers and preschoolers, parents will be the ones providing age-appropriate explanations on things like social distancing and hand hygiene on a need-to-know basis.
  • Younger children will benefit from the use of social stories; The National Child Traumatic Stress Network has examples. Children also benefit from informational shows such as the CNN/Sesame Street COVID-19 town hall.
  • Avoid having the TV constantly on to avoid unintended exposure to scary media and inappropriate content.
  • If children ask you questions and you don’t know the answer, look up the answer using trusted sources such as the Centers for Disease Control and Prevention.

Older children/teenagers and media

  • Have a conversation with them about COVID-19.
  • Asking open-ended questions to get their understanding of what the virus is, their opinion on how dangerous it is, and their take on the necessity of social distancing can be a great place to start.
  • Getting an idea of what their friends are saying on social media can be helpful, as adolescents tend to shift their thinking toward opinions from their peer group.
  • Once you have an idea of your teenager’s knowledge base and opinions on COVID-19, confirm the right facts. If you aren’t sure, that’s OK! Look up information on reputable sources like the CDC or World Health Organization.
  • Gently challenge any false notions and provide information from trusted sources as evidence.

Media tips for all children

  • Set boundaries. Excessive use of media is associated with negative psychological and physical consequences including depression and obesity.
  • Set limits for daily use. Encourage active interpersonal exchanges such as video chats with same-age peers, and steer children away from using electronics solely for passive activities such as watching videos.
  • Be sure that your child is also spending time away from electronic devices, engaging in physical activity, and other social and educational activities.
  • Model appropriate consumption of media and reactions to news reports. Obtain critical updates from reliable sources once or twice a day.
  • Avoid sensationalism or repeated coverage of the same information.
  • Check in with yourself – am I distressed or agitated? If so, turn it off and pursue other activities. Although some level of worry, confusion, or sadness is to be expected, if your child senses you are feeling overwhelmed and hopeless, they will be more likely become emotionally dysregulated as well. React calmly and provide reassurance so that your child will follow suit.

If your child is expressing excessive worry, anxiety or hopelessness about COVID-19, it may be a good idea to limit his/her exposure to news and social media. With the flood of potential misinformation from social media as well as repeated exposure to distressing  content on the news, your child may start to think that the future is hopeless and that his/her own health is at serious risk. Combat this impression by focusing on the measures that your family is currently taking to limit risk of infection as well as steps that your child or teenager can take to ensure continued health and safety. Take time to have a discussion about interesting and fun activities that your child can participate in that follow the public health recommendations.

Get more information on Coronavirus (COVID-19)

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Tips for making the most of your first mental health telehealth appointment

By Dr. Sabrina Stutz, pediatric psychologist at CHOC Children’s

Mental health services don’t always need to be carried out in person. Services can be delivered via a smartphone, tablet or computer. You and your child can engage in mental health services for telehealth from any private location with internet access.

If you are new to mental health telehealth services, here’s a guide for how you can prepare for your visit virtual appointment and what to expect, plus benefits of telehealth for mental health and answers to some commonly asked questions.

What happens before my first visit?

  • CHOC’s psychology team will email you a secure link for your virtual appointment. It is recommended that you practice signing onto the teleconference link prior to your visit.
  • We will also email a link to consent to mental health evaluation and treatment, for you to review and sign prior to your appointment.
  • We recommend that you find a place with stable internet service and good lighting in which you and/or your child can speak openly and freely with privacy.
  • Please ensure that a parent or adult caregiver will be physically present in the same location as the child at all times during telehealth mental health visits in case of emergency.

Who needs to be at the first telehealth mental health session?

Both a legal guardian and the child should be present at the beginning of the first session to go through the consenting process. It is recommended that the primary caregiver and the child be in the same physical location for the first appointment.

What will we talk about?

Your clinician will introduce themselves and confirm that a legal caregiver and child are present. They will review and confirm your contact information in the event of technology disruption or an emergency. Then, your clinician will review the consent process and answer any questions about using the teleconferencing software.

After the family consents to services, the clinician may wish to speak to the parent(s) and child separately. Your provider will review your concerns and your child’s history, and will offer feedback and recommendations/resources at the end of your visit. They will also answer any questions or concerns you may have about your child’s symptoms.

Is telehealth therapy as effective as in-person therapy?

Yes! Telehealth-delivered therapy techniques have been studied for over a decade. Many evidence-based therapies have research to prove that they are just as, if not more effective when delivered via telehealth. Cognitive behavior therapy (CBT), trauma-focused interventions, and parent-coaching models all have research to support their effectiveness when delivered online by a trained, licensed provider. Some minor adaptations can be made to ensure appropriate delivery of most evidence-based outpatient therapeutic interventions online.

What are the benefits of receiving mental health therapy via telehealth?

Telehealththerapy is a great way to access mental health services from the safety, comfort and convenience of your own home. Here are some of the other benefits of telehealth delivered therapy that families and clinicians have shared:

  • Families find it easier to attend sessions.
  • Families have flexibility in their schedule when cutting out commute time.
  • There are reduced childcare costs for untreated siblings.
  • Families save time, especially during high-traffic appointment times or when living far away.
  • Therapy is still accessible when on vacation within the state of California.
  • Children who might be nervous to do therapy feel more at ease using telehealth for a first session. Then, they are more likely to follow-up with telehealth mental health sessions afterwards.
  • Family members in separate locations can both attend a therapy session without having to be in the same location.
  • Parents at work can call in on their breaks to participate in family sessions.
  • Children and families are better able to remember and use coping skills when they have learned and practiced them in their own home environment.
  • Clinicians can see and live-coach families through difficult home-based situations like picky eating at mealtimes, setting behavioral limits such as a time out, or supporting a child in accepting a medical intervention such as  injections, pill-swallowing or nebulizers.
  • Clinicians have a richer and more nuanced understanding of families when they can see them in their home environment.
  • Clinicians can make more personalized and immediate recommendations. For example, “That looks like a great spot to put a reminder to check your blood sugar! Let’s create a reminder together and put it up during our session today.”

My child has trouble keeping their attention on the screen. What can you do for them?

The mental health community has created inventive and engaging ways to keep a child engaged over telehealth! Your clinician will talk with you and observe your child to assess their capacities for sustained attention, and can adapt interventions to fit their needs. For some children, we may ask parents to print out or set up certain activities before the therapy session to help facilitate. Other engagement strategies include share-screen therapeutic drawing and games such as Pictionary or Heads Up, gratitude scavenger hunts, “show and tell” topics, and parent-assisted relaxation exercises. If a child is unable to interact over telehealth, parent training models in which the therapist helps coach the parent to interact therapeutically with their child, are available.

How can I ensure my privacy?

 CHOC clinicians hold your confidentiality and privacy rights during telehealth sessions as seriously as they do when you come to the office. During a mental health telehealth appointment, your clinician will be in a private space where no one can see or hear them, and will be using secure, encrypted video conferencing software. We recommend that you access any mental health telehalthe services through your own password protected device on a password protected internet network to maximize your privacy. You may also wish to use headphones in order to have a more private conversation when sharing a home with others. For some very sensitive conversations, some families have chosen to step out to their cars or another more private location.

I have to work, but my child is home with another adult. Can we do a mental health visit via telehealth?

 For the first session, it is best if a legal guardian and their child can be together in the same location. Please contact your clinician for questions about special circumstances. For follow-up sessions, it will be up to you and your clinician to determine whether it is appropriate for the parent to call in from work while the child is at home with another trusted adult caregiver. Please talk to your clinician in advance of any adjustments that might need to be made for the supervision of your child during scheduled therapy sessions.

What if my child has very serious mental health symptoms?

If your clinician feels that your child’s mental health symptoms are too severe to manage over telehealth, they will review their recommendations and alternative options with you.

If you are concerned your child may be having a mental health emergency, do not wait for a telehealth mental health appointment. Instead, contact one of the crisis lines below, go to your nearest emergency department, or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team: 866-830-6011

If it becomes clear to a mental health clinician during the course of a telehealth session that your child is having a mental health emergency, the clinician will advise you to go to the nearest emergency room or call 911.

Learn more about mental health services at CHOC

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Tips for parenting a child who is depressed

We understand that in these very difficult times, children and teens can struggle with feelings of depression.

If you are a parent who is concerned about your child or one of their friends, here are tips for starting the conversation. This guide on common sayings to avoid, and what to say instead, can help as well.

Below are parenting tips for a child or teen who is depressed, from the mental health experts at CHOC Children’s:

  • Show your love. Children need love, empathy and respect. Let them know you care and that this is important. Just be present, sit with them and reassure them that you understand how they feel.
  • Make a date. Schedule time to spend with your child, even if they won’t talk during this time. Schedule pleasant activities, preferably out of the house and active such as walking or going to the park. Before and after the COVID-19 pandemic, these dates might look like going to a movie or getting ice cream. Your child may not want to engage in activities. Encourage them to do it anyway.
  • Stick to a routine. Schedules and routines create a sense of structure and security. Make things seem normal – even though they may not be. Learn more about creating structure and routine for kids during COVID-19.
  • Focus on the positives. Track your ratio of negative to positive comments to your child. Your goal should be one negative to five positives.
  • Stay calm. Kids who are depressed are very sensitive. Small things set them off, so communicate calmness through your voice and body language.
  • Develop a positive environment and atmosphere to help your child relax. Make a list of fun things to do and follow through with them.
  • Take care of yourself. Find a support group, exercise, or ask another adult in the home to stay with the kids so you can relax. You have to take care of yourself before you can take care of your child. Learn more about how parents can deal with stress during COVID-19.
  • Find treatment for your child. Your child may benefit from some treatment to help them feel Options include therapy/counseling and medications. Speak with your doctor to determine what will work best for your family.
  • Get help. If your child expresses thoughts about wanting to kill themselves or is saying scary things, call 911 or bring your child to your local emergency department.

Helpful books for parents of children who are depressed:

  • “Depressed Child: A Parent’s Guide for Rescuing Kids” by Douglas A. Riley
  • “Help me, I’m sad: Recognizing, Treating and Preventing Childhood Depression and Adolescent Depression” by David G. Fassler and Lynne S Dumas
  • “Lonely, Sad and Angry: How to Help Your Unhappy Child” by Barbara D. Ingersoll
  • “Raising Depression-Free Children: A Parent’s Guide to Prevention and Early Intervention” by Kathleen Panula Hockey
  • “The Childhood Depression Sourcebook” by Jeffrey A. Miller

If you or your child are thinking about suicide or hurting yourself, please use one of these resources:

If you or your child is in immediate crisis and/or danger, you can call the Orange County Behavioral Health Crisis Assessment Team (CAT) at 1-866-830-6011. They will come to where the child is to do a safety evaluation. You can also call 911 or proceed to the nearest emergency department.

If you or your child is struggling, you can access these resources 24 hours a day:

  • California Youth Crisis Hotline 1-800-843-5200
  • Suicide Prevention Center 1-800-784-2433
  • Suicide Prevention Lifeline 1-800-273-8255 (TALK)
  • Crisis Text Line 741741
Learn more about mental health services at CHOC

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